MEDICARE: MRS. AUGUSTINA B BONSU NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	A0808392	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	318353YNVL	OTHER	TX	MEDICARE IND
3	00115X	OTHER	TX	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2035487-01	OTHER	TX	GROUP TPI
4	8916ND	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1194963215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUGUSTINA B BONSU NP

Provider Business Mailing Address
First Line	:	850 CENTRAL PKWY E
Second Line	:	SUITE 275
City	:	PLANO
State	:	TX
Zip	:	75074-5561
Country	:	US
Telephone Number	:	972-881-4688
Fax Number	:	972-881-4609

Provider Business Practice Location Address
First Line	:	850 CENTRAL PKWY E
Second Line	:	SUITE 275
City	:	PLANO
State	:	TX
Zip	:	75074-5561
Country	:	US
Telephone Number	:	972-881-4688
Fax Number	:	972-881-4609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	04/23/2026

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